Mesh : Humans Female Middle Aged Male Small Fiber Neuropathy Case-Control Studies Retrospective Studies Fatigue Syndrome, Chronic Post-Acute COVID-19 Syndrome Immunoglobulins, Intravenous COVID-19 Autonomic Nervous System Diseases

来  源:   DOI:10.1212/NXI.0000000000200244   PDF(Pubmed)

Abstract:
OBJECTIVE: To report a case-control study of new-onset small fiber neuropathy (SFN) after COVID-19 with invasive cardiopulmonary exercise testing (iCPET). SFN is a critical objective finding in long COVID and amenable to treatment.
METHODS: A retrospective chart review was conducted on patients seen in the NeuroCOVID Clinic at Yale who developed new-onset SFN after a documented COVID-19 illness. We collected demographics, symptoms, skin biopsy, iCPET testing, treatments, and clinical response to treatment or no intervention.
RESULTS: Sixteen patients were diagnosed with SFN on skin biopsy (median age 47, 75% female, 75% White). 92% of patients reported postexertional malaise characteristic of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and 7 patients underwent iCPET, which demonstrated neurovascular dysregulation and dysautonomia consistent with ME/CFS. Nine patients underwent treatment with IVIG, and 7 were not treated with IVIG. The IVIG group experienced significant clinical response in their neuropathic symptoms (9/9) compared with those who did not receive IVIG (3/7; p = 0.02).
CONCLUSIONS: Here, we present preliminary evidence that after COVID-19, SFN is responsive to treatment with IVIG and linked with neurovascular dysregulation and dysautonomia on iCPET. A larger clinical trial is indicated to further demonstrate the clinical utility of IVIG in treating postinfectious SFN.
METHODS: This study provides Class III evidence. It is a retrospective cohort study.
摘要:
目的:报道一项有创心肺运动试验(iCPET)对COVID-19后新发小纤维神经病变(SFN)的病例对照研究。SFN是长期COVID的关键客观发现,适合治疗。
方法:对在耶鲁大学NeuroCOVID诊所看到的患者进行回顾性图表回顾,这些患者在有记录的COVID-19疾病后出现了新发SFN。我们收集了人口统计,症状,皮肤活检,iCPET测试,治疗,以及对治疗或无干预的临床反应。
结果:16例患者在皮肤活检中被诊断为SFN(中位年龄47岁,75%为女性,75%白色)。92%的患者报告了肌痛性脑脊髓炎/慢性疲劳综合征(ME/CFS)的运动后不适,7名患者接受了iCPET,这表明神经血管失调和自主神经失调与ME/CFS一致。9名患者接受了IVIG治疗,7例患者未接受IVIG治疗。与未接受IVIG的患者(3/7;p=0.02)相比,IVIG组的神经性症状(9/9)出现了显着的临床反应。
结论:这里,我们提供了初步证据,表明在COVID-19后,SFN对IVIG治疗有反应,并与iCPET上的神经血管失调和自主神经功能障碍相关.一个更大的临床试验表明,进一步证明了IVIG在治疗感染后SFN中的临床实用性。
方法:本研究提供了III类证据。这是一项回顾性队列研究。
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